Difference in Treatment Outcome in Outpatients With Anxious Versus Nonanxious Depression: A STAR*D Report

作者：Maurizio Fava, Augustus John Rush, Jonathan E. Alpert, Goundappa K. Balasubramani, Stephen R. Wisniewski, Cheryl N. Carmin, Melanie M. Biggs, Sidney Zisook, Andrew F. Leuchter, Robert H. Howland, Diane Warden, Madhukar H. Trivedi · 发表于：American Journal of Psychiatry · 年份：2008 · DOI：10.1176/appi.ajp.2007.06111868 · 被引用次数：942 · 研究领域：Treatment of Major Depression、Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes、Mental Health Treatment and Access

OBJECTIVE: About half of outpatients with major depressive disorder also have clinically meaningful levels of anxiety. The authors conducted a secondary data analysis to compare antidepressant treatment outcomes for patients with anxious and nonanxious major depression in Levels 1 and 2 of the STAR*D study. METHOD: A total of 2,876 adult outpatients with major depressive disorder, enrolled from 18 primary and 23 psychiatric care sites, received citalopram in Level 1 of STAR*D. In Level 2, a total of 1,292 patients who did not remit with or tolerate citalopram were randomly assigned either to switch to sustained-release bupropion (N=239), sertraline (N=238), or extended-release venlafaxine (N=250) or to continue taking citalopram and receive augmentation with sustained-release bupropion (N=279) or buspirone (N=286). Treatment could last up to 14 weeks in each level. Patients were designated as having anxious depression if their anxiety/somatization factor score from the 17-item Hamilton Depression Rating Scale (HAM-D) was 7 or higher at baseline. Rates of remission and response as well as times to remission and response were compared between patients with anxious depression and those with nonanxious depression. RESULTS: In Level 1 of STAR*D, 53.2% of patients had anxious depression. Remission was significantly less likely and took longer to occur in these patients than in those with nonanxious depression. Ratings of side effect frequency, intensity, and burden, as well as the ...